Reducing Opioid Use for Children Undergoing Cleft Surgery

Published on Aug 21, 2018 in CHOP News

Why is this important?

Cleft lip and palate is a congenital craniofacial condition affecting 1 out of every 600 births in the US, making it one of the most common birth differences. Incomplete formation or closure of the facial tissue early in pregnancy can result in an opening in the lip and nose, gums, and/or roof of the mouth, or palate. Children with cleft lip and palate undergo multiple surgeries throughout childhood, introducing repeated exposures to opioids to manage postoperative pain. In addition to concerns for addiction, side effects like nausea, sedation, and poor oral intake can impact recovery and affect length of stay, return to school, and the patient experience.

What we did

A multidisciplinary approach was used to identify key drivers for increased inpatient opioid administration and to target actionable methods to reduce unnecessary opioid use. Our team focused on improving postoperative communication between the OR, floor units and families, optimizing intraoperative and postoperative pain management strategies through increased use of nerve blocks and non-narcotic options and refining EPIC order sets to standardize care.

Results

Postoperative opioid use decreased by 30%, an improvement that has been sustained. Pain scores have remained stable along with the change in practice.